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Forgetfulness or Actual Memory Loss?

June 15, 2018

Are misplaced keys, forgotten names, and lost words a normal part of the aging process, or a sign that it’s time to seek help?

An estimated five million U.S. adults age 65 and older are living with Alzheimer’s disease; millions more are living with other forms of dementia. Perhaps you know one of them – or perhaps you’re concerned about changes in memory or cognitive abilities in yourself or a loved one. Is every forgotten grocery item or missed appointment a red flag?

Not necessarily, says Anjali Patel, DO, a neurologist who specializes in memory and cognitive disorders – but it’s important to investigate further. “Just as your body changes as you age, your brain changes,” she says. “Processing speed slows; you may forget a word and then it comes to you, or you may forget why you walked into a room. If you’re concerned about memory loss or concerned about cognitive changes or changes in mood, start that conversation with your physician.”

In fact, it’s even better to begin that dialogue before one notices changes. Unlike other health metrics that are easily measured and tracked (cholesterol levels, blood pressure, etc.), cognitive ability is deeply individualized and more difficult to evaluate. Dr. Patel suggests that adults in their 50s and 60s speak to their primary care physicians about simple baseline testing, which can make a decline in memory or cognitive ability easier to recognize.

Do You Have Memory Loss?

These questions may help determine if an evaluation with a neurologist should be considered.

Do you have trouble recalling words or names in conversation?

Do you have trouble concentrating?

Do you sometimes forget where you are or where you are going?

Have family or friends told you that you are repeating questions or saying the same thing over and over again?

“We offer comprehensive tests and evaluations that provide an objective measure of each patient compared to same-aged peers,” says Dr. Lebeau. As a neuropsychologist, she looks at all aspects of cognitive function – working memory, language ability, executive functions, learning and memory, visual-spatial perception, mood and more – through standardized measures. Dr. Patel provides a neurocognitive evaluation from a medical perspective, relying on a detailed exam, medical and family history, plus blood work and imaging studies, to differentiate between the normal aging process or something more.

“Sometimes changes can be subtle, like missing a bill payment,” says Dr. Patel. “We’re looking at the whole picture. When did symptoms start? Are there changes in mood? Is there a movement component? How well is the person able to care for herself or himself? We may also recommend blood work or imaging studies, such as MRI, CT and PET scan.” Also available is PET CT with CortexID™, a computer program that enables clinicians to compare a patient’s PET/CT brain scan to a database of age-matched subjects to check for abnormalities.

Not all dementia is Alzheimer’s disease, Dr. Patel points out, and here, too, differentiating is important. “‘Dementia’ is a big, broad umbrella term,” she says. “It’s like saying you own a car, but what type of car is it? There are many different types of dementia. Completing a thorough workup can help distinguish between these different forms. When we’re talking about memory and cognitive disorders, we want to know what we’re dealing with. Blood work and imaging studies can help if we are not sure of the underlying cause, or can help determine if someone is at increased risk for developing Alzheimer’s disease.” Conversely, if a workup is able to rule out dementia, this may provide reassurance to the individual and family members.

A Call to Action

“I wish dementia was not so much of a taboo,” says Dr. Patel. “People try to hide it from loved ones. But it’s OK to come forward – don’t wait until symptoms escalate and you are declining. Awareness is key. I don’t like this attitude that there is nothing we can do.”

To that end, the earlier a diagnosis can be made, the better it is for patients and families. “It is important to be evaluated early, so we can treat and make recommendations before things progress to a place where there isn’t much we can do,” says Dr. Lebeau. For those in the earlier stages of Alzheimer’s disease, for example, medications may help slow the worsening of symptoms and improve overall function and cognition.

“When you know early on what you’re dealing with, it gives a person more control of their health,” Dr. Patel adds. “It gives families time to line up legal resources like power of attorney and a health care proxy. It gives them time to make decisions, like moving the patient closer to family or finding clinical trials.” Of the latter, stresses Dr. Patel, “I encourage patients to get involved in trials and become more proactive. That’s the only way we are going to learn more about the disease process and find treatments that work.”

Although there currently is no cure for Alzheimer’s or other dementias, a proper diagnosis can change care management and improve quality of life. Compensatory strategies (keeping a calendar to track appointments, placing a whiteboard by the door for reminders, using a pillbox marked with days of the week, etc.) can be applied to support memory function. Occupational, physical, and speech therapies can be employed to cope with declining skills, and psychotherapy can help manage the psychological effects of disease progression. “There are a good number of resources, and we help to connect our patients and their caregivers with those resources,” says Dr. Lebeau, citing Atlantic Health System’s own Healthy Aging and New Vitality programs, as well as other social services such as driving evaluations and the Alzheimer’s Association of New Jersey.

“Caregivers can find support and guidance from geriatricians who work with these patients and their families,” says Michele Elkins, MD, medical director of geriatric services for Overlook. “It’s important for families to know what to expect – to understand the progression of disease and how to handle it,” she says.

Visualizing Alzheimer’s Disease

Imaging technologies enable our physicians to reach a more definitive diagnosis earlier in the disease state, when interventions can be most helpful.

What does Alzheimer’s look like? Outward symptoms can be vague and vary from person to person, especially in the earlier stages of disease. But a closer look inside the brain can provide powerful answers.

At Overlook, our neurologists often rely on brain imaging studies and collaborate with neuroradiologists (radiologists who have additional subspecialty training in imaging of the central nervous system) to help inform a diagnosis. “When a patient presents to his or her health care provider with symptoms of dementia, we’re able to provide imaging tests that help lead to diagnosis,” explains Neil Horner, MD, FACR, chief of neuroradiology for the Department of Radiology at Overlook Medical Center, and chief of neuroradiology for Atlantic Health System and Atlantic Neuroscience Institute.

“Our role in diagnosing Alzheimer’s is to exclude other causes that could lead to a decrease in cognition or higher-level functioning – things like a hematoma, brain tumor or multiple strokes – and also to assist in helping to differentiate Alzheimer’s disease from other dementia states.”

One such imaging test is a PET scan, which is used to assess how different areas of the brain metabolize glucose – a reflection of the brain’s functionality. Other tests are CT and MRI scans, both of which visualize the anatomy of the brain.

Also available at Overlook is a combined PET CT scan, with the added benefit of CortexID. “We have had the ability for the last 10 years to take a patient’s PET scan and use CortexID to improve the specificity of diagnosing dementia versus the normal aging process,” says Dr. Horner. CortexID, he explains, is a composite database that allows physicians to compare a patient’s own PET CT images against age-stratified normals and patient groups, thereby helping to differentiate between mild cognitive impairment and the normal aging process.

To date, CortexID has been used on 750 patients at Overlook. “With CortexID, we’re able to make a diagnosis before any other anatomical finding shows up,” says Dr. Horner. “An early diagnosis is what we strive for, because that’s when we are able to make the most difference.”